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 Table of Contents  
RETINAL IMAGING SECTION
Year : 2018  |  Volume : 19  |  Issue : 2  |  Page : 159-161

Optical coherence tomography angiography in choroidal neovascular membrane


Modern Ophthalmic Center, Alexandria, Egypt

Date of Submission04-Aug-2017
Date of Acceptance20-Oct-2017
Date of Web Publication7-Jun-2018

Correspondence Address:
Moemen S El-Nawawy
Modern Ophthalmic Center, 15 Mohamed Wagih Ahmed Street, Wabour El-Maya, Alexandria 21515
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DJO.DJO_48_17

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  Abstract 


Optical coherence tomography angiography is a new, noninvasive imaging technique that generates volumetric angiography images. It is quick and noninvasive and provides volumetric data, with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. It shows detailed vascular information that is promising to patients with age-related macular degeneration. We present optical coherence tomography angiography findings in a case with active choroidal neovascular membrane in one eye and inactive disease in the other eye.

Keywords: age-related macular degeneration, choroidal neovascular membrane, fluorescein angiography, optical coherence tomography angiography, optical coherence tomography


How to cite this article:
El-Nawawy MS. Optical coherence tomography angiography in choroidal neovascular membrane. Delta J Ophthalmol 2018;19:159-61

How to cite this URL:
El-Nawawy MS. Optical coherence tomography angiography in choroidal neovascular membrane. Delta J Ophthalmol [serial online] 2018 [cited 2018 Oct 18];19:159-61. Available from: http://www.djo.eg.net/text.asp?2018/19/2/159/233931




  Case report Top


A 73-year-old man presented with diminution of vision in both eyes with metamorphopsia, which was more pronounced in the right eye. There was a long-standing history of type 2 diabetes. He had received several intravitreal injections in both eyes. His visual acuity in the right eye was 0.1, whereas in the left eye was 0.05.

Fundus examination in the right eye showed an elevated grayish macular choroidal neovascular membrane (CNV) with multiple drusen in the macular area and posterior pole ([Figure 1]). Examination of the left eye showed a flat yellowish macular choroidal neovascular membrane with surrounding pigmentations and retinal drusen. Hard exudates and small dot hemorrhages could be seen in the superior temporal part of the posterior pole of the left eye ([Figure 2]).
Figure 1 Right eye showing rounded elevated macular choroidal neovascular membrane with surrounding drusen.

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Figure 2 Left eye showing macular choroidal neovascular membrane with surrounding drusen. Mid-peripheral diabetic changes could be seen.

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Fluorescein angiography was performed and late-phase images showed hyperfluorescence of the macular CNV in the right eye with late increase in intensity and in fuzzy appearance of its edges indicating leakage and activity ([Figure 3]). The left eye showed hyperfluorescence of the macular CNV with late increase in intensity only denoting staining owing to scar formation, and no leakage was detected ([Figure 4]).
Figure 3 Fluorescein angiography of the right eye showing hyperfluorescence of the macular choroidal neovascular membrane with edge fuzziness indicating leakage.

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Figure 4 Fluorescein angiography of the left eye showing hyperfluorescence of the macular choroidal neovascular membrane without leakage.

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Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) were performed. OCT of the right eye showed cystic spaces with macular elevation, and OCTA showed multiple fine vessels with anastomoses at the level of retinal pigment epithelium (RPE) that extended above the RPE (sometimes referred to as blooming tree appearance) ([Figure 5]).
Figure 5 Right eye optical coherence tomography showing cystic spaces (below) with fine vessels with end-to-end anastomoses on optical coherence tomography angiography (blooming tree appearance, above).

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Left OCT showed absence of cystic spaces, whereas OCTA showed multiple branching vessels without anastomoses at the level of the RPE and choriocapillaris (sometimes referred to as dead tree appearance) ([Figure 6]).
Figure 6 Left eye showing no activity on optical coherence tomography (below) with thicker branching vessels without anastomoses on optical coherence tomography angiography (dead tree appearance, above).

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  Discussion Top


OCTA is a new noninvasive imaging technique that employs motion contrast imaging to high-resolution volumetric blood flow information generating angiographic images in a matter of seconds. The use of the split-spectrum amplitude-decorrelation angiography algorithm improves the signal-to-noise ratio of flow detection; thus, the application of this algorithm in OCTA can assist in visualization of retinal vasculature [1]. Although fluorescein angiography remains the gold standard for determining the presence of leakage, and OCT shows fluid accumulation and its variations, OCTA may now offer noninvasive monitoring of CNV, aiding each treatment decision during the follow-up period [2].

OCTA is not without limitations. One of them is that it offers a limited field of view. Further limitations include suboptimal correction for eye motion artifacts and projection artifact from superficial vessels during imaging of deeper layers. Nevertheless, it is a powerful novel tool to assess CNV presence and activity and is quite useful in determining the need for further intravitreal injections [3].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jia Y, Bailey ST, Wilson DJ, Tan O, Klein ML, Flaxel CJ et al. Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration. Ophthalmology 2014; 121:1435–1444.  Back to cited text no. 1
    
2.
Coscas GJ, Lupidi M, Coscas F, Cagini C, Souied EH. Optical coherence tomography angiography versus traditional multimodal imaging in assessing the activity of exudative age-related macular degeneration: a new diagnostic challenge. Retina 2015; 35:2219–2228.  Back to cited text no. 2
    
3.
Lumbroso B, Rispoli M, Savastano MC. Longitudinal optical coherence tomography − Angiography study of type 2 naive choroidal neovascularization early response after treatment. Retina 2015; 35:2242–2251.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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